Khurana
Law Firm

Medicare whistleblower lawyer

Whistleblower and qui tam lawyers battling Medicare and Medicaid fraud in California

Medicaid and Medicare fraud cost California taxpayers billions of dollars every year. While the majority of medical service providers and drug companies are honest and work within the system, there are those who do not. When scams are perpetrated, everybody can lose. Medicaid and Medicare whistleblower lawyers help people who work in the healthcare system to file lawsuits on behalf of the government to report this type of fraud.

The state and federal government put a a good deal of trust in pharmaceutical and medical companies. When that trust is ill-placed, it depends on regular folks in California to come forward and to report fraud. People like you.

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Experienced Medicare and Medicaid whistleblower lawyers; representing healthcare employees in California

At Khurana Law Firm, P.C., as skilled Medicare and Medicaid whistleblower legal representatives, we support your brave choice to come forward to report abuse and fraud in the industry. We know that stepping forward is hard and numerous things may be at stake. When you come to us, your case is held in the strictest confidence .

With our comprehensive experience representing whistleblowers nationwide, we thoroughly investigate your claim, carefully prepare your case, for court, and work relentlessly with you and the federal or state government to assist in bringing deceptive Medicare or Medicaid activity to justice.

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Whistleblower Laws in California

Medicaid fraud costs taxpayers millions of dollars each year in California. The California False Claims Act allows individuals who have knowledge of Medicaid fraud the ability to file a civil complaint on behalf of the state, county, municipality, public school, or any government agency that has been defrauded.

In addition,California is one of only two states in the country with a qui tam statute that addresses fraud committed against private insurers. The California Insurance Frauds Prevention Act (“IFPA”) permits individuals to file private qui tam suits against anyone who commits insurance fraud in the State. 

Under both laws, it is a civil offense for any individual, company, or insurance company to submit fraudulent claims, misappropriate public property, deceptively avoid financial obligations, or return funds to the government. Whistleblowers who are aware of such activity can file a qui tam lawsuit to recover the harm done to the government and, in response, collect a potential reward for doing so. 

If there is a recovery by the State or other subdivision of government under the California False Claims Act, the whistleblower may be entitled to rewards of between 15-33% of the recovery. If the suit was litigated independently, the whistleblower’s reward potential increases to 25-50% of the recovery. 

If there is a recovery by the state under the IFPA, the whistleblower may be entitled to rewards of between 30-40% of the recovery if the government intervenes and 40-50% of the recovery if the government does not intervene.

If you are a Nevada healthcare worker, get in touch with Nevada Medicare Whistleblower attorney.

Liability of the Defendant in California

Under the California False Claims Act, the defendant may be ordered to pay up to three times the amount of harm to the government in addition to fines of $5,500 to $11,000 per violation. 

Statute of Limitations in California

In California, individuals filing a whistleblower lawsuit under the California False Claims Act must generally file their complaint within six years of the violation, but there may be extensions in some instances.

Working With an Experienced Whistleblower Attorney

If you have become aware of fraudulent Medicaid activity against the state of California or fraudulent activity against a private insurance company, you should get the legal advice and guidance of an experienced whistleblower attorney. At Khurana Law Firm, P.C., we have dedicated our practice to whistleblowers and combating fraud. Contact us for a confidential, no-cost consultation to discuss your case. 

What is

Medicare Advantage Fraud

Medicare Advantage (MA) plans are privately run healthcare options offering Medicare-eligible individuals additional services that are not included in traditional Medicare. These organizations receive payment from Medicare for each of their members that vary according to their risk adjustment. Some Medicare Advantage organizations overestimate and exaggerate a member’s risk or a patient’s diagnoses to get higher payments from Medicare. They do this by:

Upcoding

The MA provider increases the severity of the patient’s condition, submitting a more serious diagnosis code to get paid by Medicare at a higher rate.

Chart reviews

The MA provider reviews charts to add additional diagnosis codes.

Chart mining

The MA provider mines patient’s charts to look for conditions that are not current but can put as current to increase their payments from Medicare.

Adding unsupported diagnosis

Coders are directed to add codes based on other information in the chart.

Not removing old diagnosis codes

The MA provider increases the severity of the patient’s condition, submitting a more serious diagnosis code to get paid by Medicare at a higher rate.

Sham RADV audits

The MA provider reviews charts to add additional diagnosis codes.

Incentivizing doctors

The MA provider mines patient’s charts to look for conditions that are not current but can put as current to increase their payments from Medicare.

Pre-filling charts

Coders are directed to add codes based on other information in the chart.

If you suspect Medicare Advantage Fraud, you can report it here.

Khurana Law Firm, P.C.
Medicare Fraud
Medicare Fraud is a Serious Problem

While there are no exact figures concerning Medicare fraud, we do know it is a huge problem. In the fiscal year 2020, the government recovered over $1.8 billion in civil and fraud claims relating to the healthcare industry. 

$ 0
Recovered only in 2020
YOU, the healthcare worker, provide the most vital role in combating Medicare abuse and fraud.

Watching for fraud and abuse within your organization, practice, or provider’s office helps protect everyone from this taxpayer drain and holds abusers accountable.

So what is Medicare Fraud?

Fraud, as it relates to Medicare, is when individuals or entities make false statements or representations to benefit themselves at the expense of the Medicare program. 

Who defrauds Medicare?

Medicare fraud can involve numerous individuals, organizations, and entities, including physicians and nurses, physician-owned groups, drug companies, home health providers, medical device providers, nursing homes, and others.

How do people and companies commit Medicare fraud?

Fraud and abuse come in many different forms from coding abuses, to kickbacks, to altering records, to organized crime infiltration. Each method benefits the abuser while costing taxpayers billions. 

What laws protect Medicare from fraudulent activity?

The False Claims Act, Anti-kickback Statute, Stark Law, and Federal Criminal Healthcare Fraud Statute hold abusers accountable for their fraudulent activity. 

What government agencies protect against Medicare fraud?

Many government agencies strive to protect and promote the integrity of Medicare. These include the Centers for Medicare and Medicaid Services, Center for Program Integrity, US Department of Health and Human Services, and US Department of Justice, all attempting to keep Medicare fraud at bay. But they rely on people like YOU to be their eyes and ears.

How can I help?

If you see abuse and fraudulent activity you should report it. In some cases, you may even be entitled to a reward. To report Medicare fraud, contact the experienced whistleblower lawyers at Khurana Law Firm, P.C. for a confidential consultation. 

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Work With A NATIONALLY RECOGNIZED WHISTLEBLOWER LAWYER

If you’ve become aware of potential fraud that may concern Medicare or Medicaid, you need the guidance of a skilled whistleblower lawyer, someone who can make sure that your claim is completely investigated and filed accurately and quickly. By working with a knowledgeable attorney you are increasing the chance that the federal or state government will intervene, thus increasing your chances for a financial reward. Reporting Medicare and Medicaid scams is a complicated matter –  don’t try to do this alone, we are here to help.

At Khurana Law Firm, P.C., we have years of experience as national qui tam attorneys to help in your fight against Medicaid and Medicare fraud. After you get in touch our lawyers will evaluate your case on a confidential, no-obligation basis. If we believe that you have a valid claim, we may represent you in a qui tam claim to help report the fraud and allow you to collect a reward. Because all whistleblower cases are on contingency, you pay nothing up until there is a recovery. Contact us today to learn how we can help.

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